DOCUMENT RESUME

ED 307 565 CG 021 735

AUTHOR Miah, M. Mizanur RahmanTITLE An Evaluation of the Training Program: "The

Alzheimer's Disease Afflicted: Understanding theDisease and the Resident."

INSTITUTION Illinois State Dept. of Public Aid, Springfield,PUB DATE 87

NOTE 59p.; One of a series of reports issued under the theheading: "1987 Long Term Care Research andDemonstration Projects. Final Reports. New Horizonsin Long Term Care." (see CG 021 733, 734).

PUB TYPE Reports - Research/Tecl-nical (143) --Tests /Evaluation Instruments (160)

EDRS PRICE MF01/PC03 Plus Postage.DESCRIPTORS *Alzheimers Disease; *Caregivers; Employee Attitudes;

Employees; *Nursing Homes; *Program Effectiveness;*Staff Development; *Training Methods

ABSTRACTThis study was undertaken to evaluate a training

program on understanding Alzheimer's disease for nursing homecaregivers of those with the disease. A pretest/posttest designcontrol group methodology was used to evaluate 81 staff members.Results of the study showed that: (1) staff satisfaction with workingwith mentally impaired and demented residents improved significantlyafter training; (2) the kind of knowledge required to care forAlzheimer's disease afflicted persons also increased; (3) properknowledge of various tasks and positive attitudes toward the patientsincreased; and (4) the training group showed improved self-esteemafter the training. Limits of the study were the voluntaryparticipation of the staff and the smaller than desirable samplesize; lack of participation in all training sessions; and the lack ofmultivariate analysis instead of the pretest/posttest strategy whichwas used. Despite limitations, overall results suggest that atraining program such as this one is worth repea.ing and replicatingin view of the urgent needs of persons afflicted with Alzheimer'sdisease residing in nursing homes. (ABL)

f

* Reproductions supplied by EDRS are the best that can be made* from the original document.

1

BEST COPY AVAILABLE

AN EVALUATION Or THE TRAINING PROGRAM:

"THE ALZHEIMER'S DISEASE AFFLICTED: UNDERSTANDING

THE DISEASE AND THE RESIDENT"

by

M. Mizanur Rahman Miah, Ph.D.

Southern Illinois University at Carbondale

Andrew Marcec, Project Director

Helen Porter, Co-Project Director

Lt

NIP.

CVCD

CDIllinois Department of Public Aid

Long Term Care Research and Demonstrations Projects

Jo Ann Day, Ph.D., Project Manager

The statements contained in this report are solely those of the authors

and do not necessarily reflect the views or policies of the Illinois

Department of Public Aid. The authors assume responsibility for the

accuracy and completeness of the information contained in this r,.port.

U E DEPARTMENT OF EDUCATIONMee of Educauona)Research and imorove-nent

EDUCATIONAL RESOURCES INFORMATION

receivel from person or oronizationoriginating itMinor changes have been made to ,provereproductu n quality

Points 01 view Or opinions slated in this docu-ment do not Talitlaarny reprLerdOERI positron or policy

PERMISSION TO REPRODUCE THISMATERIAL HAS BEEN GRANTED BY

Tea; 011er r tt

TO THE EDUCATIONAL RESOURCESINFORMATION CENTER (ERIC)."

4=1111Nwl!

Illinois Department ofPublic AidEdward T. Duffy, Director

viversroms

U S DEPARTMENT Or EDUCATIONOffice of Educations( Research and Improvement

EDUCATIONAL RESOURCES INFORMATIONCENTER (ERIC)

EY< document has been reproduced asreceived from the person or organizationoriginating it

C Minor changes have berm made to improvereproduction quality

Points of view or opinions stated in thisdocuMen! do not necessarily represent officialOEM position or policy

_ "PERMISSION TO REPRODUCE THIS.0111110 MATERIAL HAS BEEN GRANTkD BY

TO THE EDUCATIONAL RESOURCESINFORMATION CENTER (ERIC)"

NEW HORIZONS IN LONG TERM CARE'

J2=TMLMr--A0.4MO.M----aMMMb--IMMW.MMMENM-eMp

VO.--OINA/11.-

Edward T. DuffyDirector

Illinois Department ofPublic Aid

Jesse B. Harris Building100 S. Grand Avenue EastSpringfield, Illinois 62762

Funds for collaborative research in long term care were appropriated in

the Department of Public Aid's budget in Fiscal Years 1986 and 1987 to

find new ways to treat long term rare patients in Illinois nursing

homes. The $2.5 million appropriation over the two years anabled the

State, academic institutions, and providers of long term care to pool

their talents for the first time. In all, there were 17 projects funded

in Fiscal Year 1986 and 14 projects funded in Fiscal Year 1987, the final

year of the Long Term Care Research and Demonstrations projects. The

attached document is the final report from one of the 1987 projects.

The Department of Public Aid expects the ideas generated by these

projects to be put into reality. There are, in fact, training programs

already being disseminated as a result of the research.

This report is one of a series of reports that comprise the long term

care projects funded during 1987. Copies of the other reports are

available from the Department of Public Aid by writing to Jo Ann Day,

Ph.D., Long Term Care Research and Demonstration Project Director, Office

for Employment and Social Services.

Sincerely,

geld(Edward T. Duffyenc.

ETD:JD:gt

1.;

ACKNOWLEDGMENTS

A project of this importance and magnitude required a commitment from

many individuals. Among those are Richard A. Ligon, Administrator,whose support at the onset of the idea's inception to its closure must

be credited. His support among the caregivinq staff enlisted the

participation ol the personnel in the facility. He kept abreast of

the projects's activities by participating himself.

Bill Krzykowski, Business Office Manager, is credited too for his apt

handling of the financial procedures with the nursing home ascontractor with the University. Marge Eisenhauer, R.N., Director of

Nursing Services, was most instrumental as she lent the power of her

office to encourage personnel to participate. In her absenc,,

Stephanie Green, R.N., Associate Director of Nursing Services, kept

the momentum going. There were others whose ancillary activities and

support contributed. Dan Marsh, Geriatric Counselor, Jackson County

Community Mental Health promoted the project among family members of

Alzheimer residents at the support groups he conducts. Connie J.

Armstrong directed support group of Jackson County Nursing Home

personnel most ably. Then there were collectivities of other persons

from the nursing home. Most notably the Employees Relations Council

whose interest was displayed in many different and effective ways.

And of course, the affable Andrew R. Esposito, M. D., Medical Director

for the nursing home, was as he always is, a positive force of

encouragement.

Externally, Dr. Jo Ann Day, Project Manager, Long Term Care Research

and Development Projects, was so helpful in evaluating constructively

and in a gentle manner the Project's proceedings. Special kudos to

this lady for her guidance.

On the outside too were those wonderful people from the Randolph

County Nursing Home, Sparta, Illinois who functioned as the control

group. Our thanks to Jeannette Buch, Administrator, and to Janice

Mergelkamp, R.N., Director of Nursing Services, who solicited such a

fine turnout of caregivers to take the pre and post test instrument

measures.

John M. Ross, the administrator of the River Bluff Nursing Home,

Rockford, Illinois gets credit for designing the incentive patch given

to the Aff who achieved the project's goals for attendance and

participation.

A debit of gratitude to the principals to the project who grey:

personnally and professionally with each phase and who worked so well

together as a team. Those persons are:

Andrew H. Marcec, M.S., Projector Director, Division of

Continuing Education, Southern Illinois University,

Carbondale, IL

Helen Porter, B.S. Social Work, Director of Social Services,

Jackson County Nursirg Home, Murphysboro, IL

David Parrent, B.S., Research Associate, Division of

Continuing Education, Southern Illinois University,

Carbondale, IL

M. Mizanur Rahman Miah, Ph.D, Visiting Professor, School of

Social Work, Southern Illinois University, Carbondale, IL

Pamela Peoples, Secretarial Associate, Division of Continuing

Education, Southern Illinois Univsersity, C,rbondale, IL

Douglas E. Thompson, B.S., Copy Editor, student, School of

Medicine, Southern Illinois University, Carbondale, IL

6

TABLE OF CONTENTS

Page

I. INTRODUCTION 1

II. METHODS 4

A. Questionnaires 4

1. Questionnaire I and Measures 4

2. Questionnaire II and Measures 7

B. Sample 8

C. Procedures. 8

D. Analysis Strategy 9

11III. FINDINGS

A. i)emographic Characteristics 11

B. Knowledge of Dementia 14

C. Responsibility for Tasks 16

D. Work Satisfaction 18

E. Attitudes Towards the Alzheimer's Residents 21

F. Self-Esteem 24

29IV. DISCUSSION

V. CONCLUSION

APPENDICES

Appendix 1:Appendix 2:Appendix 3:Appendix 4:Appendix 5:

Appendix 6:Appendix 7:

32

35

Questionnaire I, "Kick-Off Exercise" 35

Questionnaire II, "Sliding Person Measure" 41

Knowledge Exercise Items 44

Responsibility for Tasks items 46

Work Satisfaction Items. 47

Attitude Towards Alzheimer's Residents Items 48

Sliding Person Measure Items 49

BIBLIOGRAPHY 50

7ii

LIST OF TABLES

Page

1. Frequency, Percentage and Mean Distribution of Age of the

Respondents for Jackson County Nursing Home and Randolph County

Nursing Hone 11-

2. Frequency Distribution of Respondents' Sex, Education, Work

Experience, and Position by Nursing Home 13

3. Pre- and Post-Test Results of Percent of Correct Responses to

Twenty "Knowledge" Items by Nursing Home 15

4. Pre- and Post-Test Mean and Standard Deviation for the Twenty

Knowledge Items by Nursing Home 16

5. Pre- and Post-Test Results for Percent of Correct Answers on the

Sixteen "Responsibility for Tasks" Items by Nursing Home 17

6. Pre- and Post-Test Mean and Standard Deviation for Sixteen

Responsibility for Tasks Items by Nursing Home 18

7 Pre- and Post-Test Mean and Standard Deviation for the Nine

"Work Satisfaction" Items for Jackson County Nursing Home and

Randolph County Nursing Home 19

8. Mean and Standard Deviation for 00 Work Satisfaction Scale by

Nursing Home and Pre- and Post-test Measures 21

9. Mean and Standard Deviation for the Fifteen Items on Attitudes

Towards the Alzheimer's Residents by Nursing Home and Pre- and

Post-Test Measures 22

10. Pre- and Post-Test Mean and Standard Deviation for Attitudes

Scale by Nursing Home 2'

11. Mean and Standard Deviation for the Ten Item "Sliding Person

Measure" by Nursing Home 25

12. Pre- and Post-Test Mean and Standard Deviation for "Sliding

Person" Scale by Nursing Home 26

13. Independent T-Test Results for Knowledge, Tasks, Work Satisfaction,

Attitude and Self-Esteem Scale Scores by Jackson County Nursing Home

and Randolph County Nursing Home 27

1 i4

I. :NTRODUCTION

The major objective of the project, "The Alzheimer's Disease

Afflicted: Uoderstanding The Disease and the Resident," was to make the

allied health personnel more sensitive to the special needs and treat-

ment of the aged suffering from Alzheimer's Disease (AD). It was

assumed that incumbent practitioners do not have the special skills and

knowledge that will allow them to appropriately treat the Alzheimer's

resident. Similar concern was also expressed by Dietsch and Pollman

(1982) who observed that in basic nursing education, training and eauca-

tion regarding Alzheimer's disease and related disorders are at best

minimal. Our training program was designed to address sucl, needs in one

of the nursing homes in Southern Illinois, namely, the Jackson County

Nursing Home (JCNH). In all, seven training Fessions were organized for

its staff members who are directly or indirectly involved in Alzheimer's

resident care. A brief description of the training sessions by date

follows:

December 12 1986: The first training session took place with Mary

Barringer, R.N., the presenter. She spoke on what the participants

would learn over the next few months, and outlined what Alzheimer's

Disease is.

January 29 1987: The second training session, "Communication

Skills," was presented by Mary 3arringer, R.N., and Nelly Ryan, M.S.W.

This in-serice session dealt with communication skills which aid .in

caring for AD residents.

1

February 25 1987: A training tool called "Communication

Exercise" was given to staff on a voluntary basis. This was designed to

re-enforce what was taught at the first and second training session.

March 3 1987: The third training session, "Understanding the

Family's Burden," was presented by Nelly Ryan, M.S.W. This in-service

described what the families of residents have gone through prior to

admission of their afflicted family member to the nursing .come.

April 2 1987: Training session four took place in tfe form of an

event outside the nursing home. The project sponsored a live broadcast

of an AD teleconference out of Nashville, Tennessee. The conference was

directed towards family members of AD victims but was applicable for

nursing home staff as well.

April 16 1987: The fifth training session, presented by Ma "y

Barringer, was "Care Strategies." After a video tape was ;hewn there

was a discussion with the staff concerning how to care for confused

residents in various situations.

May 22, 1987: The sixth training session, "Sensory Loss," was

presented by Catharine Kopac, R.N., Ph.D. This in-service was meant to

teach the staff what it is like to experience the loss of the ability to

touch, see, and hear. The staff wore rubber gloves, blindfolds, and

earplugs.

June 9 1987: The seventh and final training session, "Dying and

Bereavement," was presented by Betty J. Walston, R.N., Ph.D. This

in-service talk dealt with the grief which comes when a resident the

staff has cared for dies.

This report contains ar evaluation of outcomes of this training

program, its strengths and weaknesses, and its implIcations for future

training programs.

II. METHODS

A quasi-experimental pre- and post -tests control group design (see

Campbell and Stanley, 1963, for detail on this design) was used for the

evaluation of the training program. Jackson County Nursing Home (JCNH),

whose staff participated in the training program, was the experimental

group. Another ccunty nursing home, the Randolph County Nursing Home

(RCNH), served as a control group.2

Questionnaires

Two separate self-administered questionnaires were used once during

pr,: -test and once during post-test for both experimental and control

groups.

Questionnaire I and Measures:

This assessment tool (see Appendix 1) was originally developed by

Springer and Brubaker (1984) and was used successfully by the Department

of Medical Social Work, University of Illinois at Chicago, in their

assessment of the caregivers traininy program at the Alzheimer's Disease

Training Center, Chicago, Illinois. Questionnaire I contained four

specific dimensions that were used to gather the data for this evalua-

1 Pre-test in this report refers to measures taken in the pre-training

Phase of the study, and post-test refers to measures taken after the

training programs were over. Thus, the terms pre-test and pre-

training, and post-test and post-training are used interchangeably

throughout this report.

Originally one more nursing home, the River Bluff Nursing Home,

Rockford, Illinois, agreed to serve as a second control group. But,

since the post-test evaluation results could not be obtained from

them, the final report excludes this nursing home from the analysis.

le

tiun study. These were: (1) Knowledge of Dementia; (2) Understanding

about Responsibility for Tasks regarding resident care; (3) Degree of

Work Satisfaction feelinas in the current job; ard (4) Attitude toward

working with cognitively impairer residents.

Measures for Krowledge dimension included 2C items having 'true' or

'false' response types (see section 8, items 1 through 20 in Appendix 11

derived from information about aging and dementia by Brubaker for family

caregivers (Springer and Brubaker, 1984). The Knowledge test had one

correct response or each item and a respondent could get zero to 20

poinf_ on this dimension (all wrong = 0; all correct = 20).

The second dimension, "Responsibility for Tasks," included 16 items

that mesa...Lined '!spondents' understanding about who they think should be

responsible for various tasks regarding Alzheimer's care (se: items 21

through 36 in Appendix 1). There could be three possible responses to

each item such as, (1) Only nursing home is responsible for tasks; (2)

Both nursing home and family are responsible for tasks (joint); and (3)

Only family is responsible for tasks. From the training point of view,

each item on this dimension also had one correct answer. Thus, a

respondent could receive a total of 16 points, if all correct, or zero

point , if all wrong.

The third dimension, "Work Satisfaction," (see items 37 through 45

in Appendix 1) measured the degree of satisfaction staff members

presently have with various aspects of their job regarding Alzheimer's

resident care. 3 This dimension included nine Likert-type five-point

response categories ranging from Very Dissatisfied (=I) to Very

3 Items on this diNensicn have been adopted from Shuttlesworth and Rubin

(1983) Task Inventory (see Shuttlesworth and Rubin, 1983, for detail).

f3

Satisfied (=5). A summative "Work Satisfaction Scale" was developed

after proper item analysis. The internal consistency of the scale

(Cronbach's alpha) for the experimental group (JCN') in the pre-test and

post-test was .75 and .74 respectively. For the control group (RCNH)

Cronbach's alpha in the pre- and post-tests were .78 and .75 respective-

ly. Scores of individual respondents on this scale could vary from a

low of nine to a high of 45 points, provided one has responded to all of

the items. A higher score on the scale means higher work satisfaction,

and a lower score, lower work satisfaction.

The fourth dimension measured the staff members' attitude toward

working with confused residents and their tamilies on 15 unidiMensional

items (see items 46 through 60). The response catt2ories for the items

were also 5-point Likert-type that ranged from Disagree Strongly (= 1)

to Agree Strongly (= 5). Like the "Work Satisfaction Scale," an addi-

tive "Attitude Scale" was developed after similar item analyses

following Statistical Packages for the Social Sciences (SPSS-X, SPSS

Inc., 1986) procedures. However, since some of the Items were negative-

ly worded (see Questionnaire I, item numbers 46, 61-64, 66, 68-70 and

72), before the item analysis they were reverse coded and ...lade compara-

ble with other items. For the Jackson County Nursing Home, the pre-test

and the post-test alpha coefficients were .61 and .66 respectively.

These coefficients for the Randolph County Nursing Home were .60 and .67

respectively. The scale scores or a respondent on this dimension could

yield a maximum of 75 points and a minimum of 15 points depending on

one's patterns of responses. A higher score on this scale would indi-

cate a strong positive attitude, and a lower score a strong negative

44

attitude about working with confused Alzheimer's residents at the nurs-

ing home. Additionally, Questionnaire I also included demographic vari-

ables, like sex, education, work experience, and job position, that

provided background information for each of the respondents.

Questionnaire II and Measures:

The second questionnaire "Sliding Person Measure" (see Appendix 2)

has also been self-administered by the respondents (SPM). The "Sliding

Person Measure" assessed the Self-Esteem of the nursing home staff.

This instrument is a rating scale and includes ten equivalent item

statements. Respondents were asked to indicate how they feel about

each of the ten statements by placing an 'X' on a horizontal line. Each

line is 100 millimeters in length. The further to the right the 'X' is

placed, the higher the respondents' Self-Esteem as measured by individu-

al statements. Each of the instruments' ten statements has been scored

by measuring how far from the left the 'X' has been placed on the line

using a metric ruler. An 'X' placed all the way to the left yielded a

score of '000,' and all the way to the right yielded '100' points for

each respondent. No response for each item was coded as '999'.

This scale was developed by Andrew Marcec and was used ir. a past

research project in the health field with an acceptable degree of reli-

ability (alpha coefficients were .79 and .81 in pre-and- post tests

respectively). In the present study the results of item analysis were

quite satisfactory. For the Jackson County Nursing Home, alpha coeffi-

cients for pre-test and post-test were .91 and .89 respectively. The

internal consistency of the scale for the Randolph County Nursing Home

in the pre-test was .83 and the post-test was .87. When used as a

175

composite Self-Esteem scale in the analysis, a respondent's total score

on this scale could vary from '0000' to '1000'; the higher score indi-

cating higher !"1f- Esteem and the lower score indicating lower

Self-Esteem.

Sample

A total of 65 staff members from JCNH completed the pre-test

Questionnaire I as compared tc 85 from RCNH. Questionnaire II in this

phase was completed by only 46 respondents in JCNH and 65 in RCNH. In

the post-test phase 36 JCNH staff completed both questionnaires, I and

II, whereas 45 RCNH staff completed both questionnaires in this phase.

Since we had to measure the effect of training, matched respondents for

both phases, responding to both questionnaire instruments, were needed.

Therefore, this evaluation report includes only the analysis of results

for 36 JCNH staff and 45 RCNH staff who completed the questionnaires in

both pre- and post-test phases.

Procedures

Pre-test data from the JCNH staff and RCNH staff were collected

through both questionnaires in January 1987. The post-test data for

JCNH and RCNH were collected in July 1987. Both pre- and post -test

questionnaires at JCNH were distributed and collected by the project

staff. The pre-test questionnaires for RCNH were delivered by the

project staff to the ICNH supervisor, who then distributed them among

the nursing home staff. The post-test questionnaires were mailed to

8 1 6

RCNH for distribution. A Project staff member picked up the post-test

questionnaires from RCNH.

Analysis Strategy

Se eral analytical techniques were used in this evaluation study

for both the experimental (JCNH) and control groups (RCNH). First, a

univariate analysis (involving frequency and percent distributions) of

respondents' background variables; Knowledge score; Responsibility for

Tasks; Work Satisfaction; Attitude toward Alzheimer's Resident Care; and

Self-Esteem was performed. This first level analysis also included

item-wise descriptive statistics on each of the dimensions of

Questionnaire I and Questionnaire II. Second, internal consis'ency

reliability, which measures the degree to which each item in the scale

relates to the others, was measured separately for the three proposed

scales through the use of Cronbach's alpha (Cronbach, 1951). Third,

summary statistics such as mean and standard deviation were calculated

by nursing homes involving the respondents' Knowledge, Task, Work

Satisfaction, Attitude, and Self-Esteem scale scores.4 Finally, both

independent and dependent t-tests were performed for the two groups

(JCNH and RCNH) to measure the significance of differences between pre-

and post-test mean scores on all four dimensions included in

Questionnaire I, and Self-Esteem mean scores in Questionndire II.

4 Several bivariate analyses between respondents' background variablesand each scale scores were performed for. the two Nursing Homes sepa-

rately. These results were statistically non-significant andtherefore, not presented in this report.

J7

Dependent t-tests were used to test the significance of mean score

changes between pre- and post-test measures for the experimental and

control group separately. Independent t-tests were used to compare both

the experimental and control groups' mean scores on all measured dimen-

sions once at the pre-test phase and again at the post-test phase. The

Statistical Packages For the Social Sciences procedures FREQUENCIES,

CONDESCRIPTIVE, and BREAKDOWN were used for obtaining summary statistics

(See SPSS-X User's Guide, 1986). The procedure RELIABILITY was used for

internal-consistency estimates. For independent t-tests, procedures

GROUPS specification was used, whereas, for dependent t-tests, PAIRS

specification was used.

III. FINDINGS

Demographic Characteristics

Aqe: Table 1 shows the age distribution of the respondents for

both training and control group. The modal category of age for JCNH is

25 and below; a little less than one-third of the respondents in JCNH

are in this age category. Whereas, the modal category of age for RCNH

is 31 - 35; about 27 percent of the respondents in this Nursing Home are

within 31 35 years of age. Although both the groups have similar

amount of dispersion in age distribution around the mean (standard devi-

ation of 10.63 for JCNH and 10.22 for RCNH), a greater proportion (15.5

percent) of RCNH staff is in the '51 and above' age category as compared

to only 5.6 percent of the staff in JCNH. The mean age of RCNH respon-

dents is 36.2 and JCNH respondents is 33.9.

TABLE 1

Frequency, Percentage and Mean Distribution of Age of theRespondents for JCNH (M =36) and RCNH (N=45)

Age group Freq.

JCNH

Percent

RCNH

Freq. Percent

Total

Freq. Percent

25 and below 11 30.6 7 15.6 18 22.2

26 30 7 19.4 4 8.9 11 13.6

31 35 3 8.3 12 26.7 15 18.5

36 40 3 8.3 6 13.3 9 11.1

41 45 5 13.9 6 13.3 11 13.6

46 - 50 5 13.9 3 6.7 8 9.9

51 and above 2 5.6 7 15.5 9 11.1

Total: 36 100.0 45 100.0 100.0

Mean: 33.9 36.2

Standard Deviation: 10.63 10.22

11 1 9

Table 2 shows other characteristics of the respondents that include

variables such as sex, educational levels, years of experience in the

current job, and whether the respondents' position involves direct or

indirect resident care.

Sex: An overwhelming majority of the respondents (89%) in both

nursing homes were females. In JCNH, out of 36 total respondents, 32

were females. In RCNH, 40 out of 45 respondents were females.

Education: The modal category of education for both groups was

high school completed and some college; 59 percent (N = 20) of the

sample in JCNH and 67 percent of the sample in RCNH (N = 30) were in

this category. Thirty-two percent of the respondents in JCNH, and 18

percent in RCNH had less than a high school education. Very few of the

respondents in either group had 'college graduation and above' educa-

tion. However, the proportion of respondents having college graduation

were almost double in RCNH compared to JCNH; 16 percent in RCNH compared

to 9 percent in JCNH.

Work Experience: An overwhelming majority of the respondents have

been employed in their respective nursing homes for more than one year.

However, this proportion is slightly higher for JCNH staff (about 88%)

compared to the RCNH staff 90%). In fact, the mean years of work

00erience for JCNH staff is 3.8 and RCNH is 3.6.

Job Position: The available responses on this variable (12 respon-

dents did not answer this question), show that a majority, but similar

proportion (71 percent in each nursing home), of respondents have posi-

tions that involve direct Alzheimer': resident cares in their facility.

5 Positions involving direct resident care ' iclude Certified Nurse

Assistant, Rehabilitation Aide, Charge Nurse, Supervising Nurse, and

Dietary Aide. Whereas, indirect resident care positions (cont.)

1220

TABLE 2**

Frequency Distribution of Respondents' Sex, Education,Work Experience, and Position by Nursing Home

Variables

Sex

JCNH RCNH Row Total

Male 4 (11.4%) 5 (11.1%) 9 (11.3%)

Female 31 (88.6%) 40 (88.9%) 71 (38.8%)

Column Total 35* (43.8%) 45 (56.3%) 80 (100%)

* missing observation = 1

Education< High School 11 (32.4%) 8 (17.8%) 19 (24.1%)

H.S. completed &some College

20 (58.8%) 30 (66.7%) 50 (63.3%)

College Grad & more 3 ( 8.8%) 7 (15.6%) 10 (12.7%)

Column Total 34* (43.0%) 45 (57.0%) 79 (100%)

* number of missing observations = 2

Work ExperienceEmployed < 1 yr 4 (12.1%) 9 (20.0%) 13 (16.7%)

Employed > 1 yr 29 (87.7%) 36 (80.0%) 65 (83.3%)

Column Total 33* (42.3%) 45 (57.7%) 78 (100%)

Mean 3.8 yrs 3.6 yrs

* number missing observations = 3

JobDirect Patient 20 (71.4%) 29 (70.7% 49 (71.0%)

Care

Indirect Patient 8 (28.6%) 12 (29.3%) 20 (29.0%)

Care

Column Total 28* (40.6%) 41 (59.4%) 69 (100%)

* number of missing observations = 12** Per:entage included in parenthesis

(cont.) include Bookkeeper, Activity Aide, Housekeeper, Social Service

Assistant, Laundry Aide, Administrative Clerk, Receptionist, and

Maintenance persons. This variable was recoded.

13 21

KNOW' EDGE OF DEMENTIA

Table 3 shows the pre-test and post-test results of the 20

Knowledge items for JCNH and RCNH. An increased percentage of JCNH

staff gave correct answers in the post-test phase on 12 items. Their

percentage of correct answers remained the same for both tests on 3

items. The percentage of correct answers declined in the post-test for

5 items in this group. In contrast, the percent of correct answers

declined for the control group (RCNH) on 9 items and increased on the

other 11 items.

1422

TABLE 3

Pre- and Post-test Results ReflectingPercent of Correct Responses to 20 "Knowledge" Items

by Nursing Home

Knowledge Items*

Percent of Correct ResponsesJCNH (N=36) RCNH (N=45)

Pre-test Post-test Pre-test Post-test

1. DEM (F) 50% 49% 60% 49%

2. LIFE (F) 92 81 80 84

3. SOME (T) 89 89 89 804. DEPEND (F) 72 69 76 78

5. COPE (T) 75 86 78 82

6. !.:TRES3 (T) 78 80 84 73

7. CGSTR (F) 64 64 76 80

8. DEC (F) 97 100 98 87

9. QUAL (T) 69 71 73 69

10. HIDE (F) 44 46 49 44

11. GDREL (T) 97 100 93 89

12. SELF (F) 75 86 76 87

13. GUILT (T) 58 71 44 47

14. RAPID (T) 78 81 84 91

15. RESHAP (F) 94 92 91 96

16. NOTALK (F) 97 97 98 91

17. CGILL (T) 53 58 51 64

18. FRSP (F) 42 37 52 42

19. CGSUP (F) 22 37 33 47

20. RESPON (T) 56 74 69 71

* Correct answer is shown within parenthesis and a fulldescription of the items is shown in Appendix 3.

When the summative scores fov all 20 knowledge items are considered

for comparison, the picture becomes more clear (see Table 4 below).

1523

TABLE 4

Pre- and Post-Test Mean and Standard Deviation (SD)

for the 20 Knowledge Items by Nursing Home

Pre-Test Post-Test

Nursing Home Mean SD Mean SD

MeanDifferelces

JCNH (N=36) 14.00 2.32 14.50 3.14 (+.50)

RCNH (N=45) 14.53 3.12 14.49 3.42 (-.04)

For EntirePopulation 14.29 2.78 14.48 3.28 (+.19)

Table 4 shows that for the Jackson County Nursing Home, the average

number of correct answers in the pre-test was 14.0, which increased in

the post-test to 14.5. The respondents in JCNH thus have experienced an

average Knowledge increase of .50 after the training. On the other

hand, RCNH respondents started off with a higher average Knowledge (mean

= 14.53) compared to the JCNH staff at the pre-test phase but have

experienced an average decline cf .04 at the post-test phase. Their

post-test mean Knowledge score was 14.49, which was slightly lower than

that of JCNH staff at post-test.

RESPOrSIBILITY FOR TASKS REGARDING ALZHEIMER'S RESIDENT CARE

On the question of who the staff think is responsible for each of

the 16-Tasks items, the percentage of correct answers increased in the

post-test on most of the items for JCNH respondents. In this group, the

percentage of correct answers went up for 11 out of 16 items as compared

to only 8 items in RCNH (see Table 5). In other words, the control

16 24

group, which did not go through the training experience, showed a

declining percentage of correct answers on almost 50% of the items (on

one item the percentage of correct answers for this group remained the

same in both tests). Whereas, the training group showed a decreased

percent of correct answers in less than one-third of the items (in 5 out

of 16). The lowest percentage of correct answers was recorded for item

number one, for both of the groups in pre- and post-tests.

TABLE 5

Pre- and Post-Test Results for Percent of Correct Answers on the16 "Responsibility for Tasks" Items by Nursing Home

Task Items*

Percent of Correct AnswersJCNH RCNH

Pre-test Post-test Pre-test Post-test

1. XFOOD (NH)** 14% 12% 18% 13%2. ROOM (Joint)*** 53 68 64 71

3. BPARTY (Joint) 77 72 73 894. REPORT (Joint) 72 78 84 84

5. DRUGS (NH) 69 56 58 446. PHONE (NH) 46 41 78 11

7. CLAIMS (Joint) 33 34 58 628. TRANS (Joint) 51 65 64 71

9. SUPP (Joint) 42 54 49 6710. WASH (Joint) 39 51 33 36

11. MARK (Joint) 22 39 44 4212. CLOTH (Joint) 33 36 44 5813. CLIP (Joint) 83 79 84 8214. HAIR (Joint) 44 58 51 6715. NEWS (Joint) 36 55 40 3616. READ (Joint) 39 53 56 44

*

* *

* * *

Correct answers are shown within parenthesis and a fulldescription of the variables is shown in Appendix 4.NH = Nursing home responsible for specific tasks.Joint = Nursing home and family (both) responsiblefor specific tasks.

1725

The results of the additive Task scores (see Table 6) for all 16

items show that JCNH respondents received a mean score of 7.47 in the

pre-test and 8.28 in the post-test. RCNH staff's mean scores in the

pre- and post-tests were 8.97 and 9.47 respectively. A comparison of

pre- and post-test mean score differences show that both groups gained

in Task Scale scores but this gain was higher for JCNH (+.89) as

compared to IICNH (+.50).

TABLE 6

Pre- and Post-Test Mean and Standard Ueviation (SD) for the16 "Responsibility for Task" Items by Nursing Home

Nursing HomePre-Test

Mean SD

Post-TestMean SD

MeanDifferences

JCNH (N =36) 7.47 2.91 8.28 2.83 (+.89)

RCNH (N =45) 8.97 2.65 9.47 2.93 (+.50)

For EntirePopulation 8.31 2.85 8.94 2.93 (+.53)

WORK SATISFACTION AT THE NURSING HOME

Table 7 shows the mean and standard deviation for each of the 9

items used to measure the degree of Work Satisfaction of the respondents

on a 5-point scale for both nursing homes.

18 26

TABLE 7

Pre- and Post-Test Mein and Standard Deviation (SD)for the 9 "Work Satisfaction" Items for JCNH and RCNH

WorkSatisfactionItems*

JCNH

Pre-test Post-test

Mean SD Mean SD

RCNH

Pre-testMean SD

Post-testMean SD

1. PAY 3.36 1.05 3.61 .93 2.44 .99 2.44 .94

2. PRAISE 2.86 1.22 3.31 1.09 2.56 1.16 2.78 1.36

3. POLICY 3.17 .88 3.03 .77 2.60 .78 2.49 1.01

4. WKCOND 3.19 .71 3.36 .76 2.89 1.09 2.73 1.14

5. COWK 2.78 1.04 2.86 1.02 3.29 .99 2.98 1.05

6. WKSAT 3.94 .98 4.03 .61 3.60 1.07 3.51 1.08

7. WKVAR 3.50 .88 3.61 .69 3.11 .93 3.42 .89

8. OTHERS 4.1/ .56 4.00 .59 3.60 1.03 3.91 .82

9. CONFUS 3.89 .78 3.71 .75 3.20 .73 3.44 .66

* A full description of the items is shown in Appendix 5.

It can be seen from the table that, to begin with, JCNH staff

showed a higher level of satisfaction for getting a chance to do things

for others (item no. 8; mean = 4.17). In the pre-test, their mean score

was slightly higher than the 'satisfaction' (code = 4) point in the

5point scale on : out of 9 items. The staff were less satisfied with

regard to 'praise' (item no. 2) for doing a good job (mean = 2.86) and

the way their "coworkers get along with each other" (item no. 5; mean =

2.78). The post-test results showed that the respondents' level of

satisfaction 4ncreased on both of these items. In addition, they showed

increasing sa ion on four other items that include their pay (item

no. 1), working conditions (item no. 4), feelings of accomplishment

(item no. 6), and the chuoce to do different things from time to time

(item no. 7) On three other items such as "the way nursing home poli-

cies are put into practiLe" (item no. 3), "the chance to do things for

others" (item no. 8) and, "the chance to work with confused residents"

(item no. 9), although th- JCNH staffs' satisfaction level went down a

little in the post-test, their mean level of satisfaction on each item

was still reasonably higher than that of RCNH.

In contrast, .he Randolph County Nursing Home staff showed lower

than average (neutral position) satisfaction on 4 out of 9 items in the

pre-test. In the post-test, their satisfaction level remained lower

than 3.0 on 5 items. These items include their 'pay', the 'praise they

get for doing a good job', "the way nursing home policies are put into

practice," their "working conditions," and the way their "coworkers get

along with each other." Their average (mean) satisfaction level,

however, increased in the post-test with regard to variables measuring

their "chance to do different things from time to time" (3.42), "chance

to do things for other people" (3.91) and "chance to work with confused

residents" (3.44).

When the overall Work Satisfaction scale scores .sere compared (see

Table 8), the post-test results indicated that, on the average, the JCNH

staff have experienced a .56 increase in their satisfaction level as

compared to a .42 increase for that of RCNH. The pre- and post-test

mean scores for JCNH were 30.86 and 31.42 respectively (maximum possible

score being 45). While the comparable mean scores for RCNH were 27.29

end 27.71 respectively.

TABLE 8

Mean and Standard Deviation for the "Work Satisfaction" Scaleby Nursing Home and by Pre- and Post-Test Measures

Pre-test Post-testDil'erences

Nursing Home Mean SD Mean SD of Mean

JCNH (N =36) 30.86 4.81 31.42 4.25 (+.5i)

RCNH (N =45) 27.29 5.35 27.71 5.25 (+.42)

Differences of Mean (3.57)* (3.71)**

For EntirePopulation 28.88 5.39 29.36 5.15 (+.48)

* Mean differedce between JCNH and RCNH at the pre-test.** Mean difference between JCNH and RCNH at the post-test.

It should be noted here that the difference in the pre-test Work

Satisfaction scale score between JCNH and RCNH was 3.57. In the post-

test this difference ircreased to 3.71, JCNH having a higher average

scale score in both the phases.

ATTITUDES TOWARDS ALZHEIMER'S RESIDENTS

From Table 9 it can be discerned that on most of the 15 items deal-

ing with measuring the attitudes toward Alzheimer's residents, staff

members in both nursing homes maintained a positive attitude. This was

true both for pre- and post-tests. It should be noted that for each

item, a mean score below 2 indicates a negative, 2 to 3 a neutral, and

above 3 a positive attitude. It should also be mentioned that item

numbers 1, 4-7, 9, 11-13, and 15 have been reverse coded to make them

equivalent with other item scale points.

21 29

On three items, both groups have maintained a consistent neutral

position across the tests. These items are:

1. "I prefer working with residents who know what they want and can

tell me their needs" (item no. 1; question no. 46, in Questionnaire

I; variable name = NOCONF);

2. "I would rather do things myself tran wait for help" (item no. 8;

question ro. 50, in Questionnaire I; variable name = IHELP);

3. "I don't feel that my work is appreciated as much as it should be"

(item no. 12; question co. 57, in Questionnaire I; variable name =

APPR).

TABLE 9

Mean and Standard Deviation for the 15 Items on AttitudesTowards the Alzheimer's Residents by

Nursing Home and Pre- and Post-Test Measures.

AttitudeItems*

CNH (N =36)Pre-test Post-testMean SD Mean SD

RCNH (N =45)Pre-test Post-testMean SD Mean SD

1. NOCONF 2.89 .78 3.05 .92 2.84 .99 2.86 .92

2. OKCONF 3.86 .99 3.66 .90 3.27 .96 3.44 .75

3. OKMNTL 3.67 .92 3.58 .99 3.47 .94 3.47 .62

4. OTHELP 3.57 1.00 3.78 .95 3.69 .97 4.02 .75

S. MYSELF 2.97 1.03 2.98 1.05 2.53 1.06 2.67 1.02

6. FAM 3.61 .80 3.31 .95 3.23 ].00 3.04 .93

7. TRBL 3.19 1.06 3.33 1.01 3.39 .89 3.28 .97

8. IHELP 3.54 1.01 3.61 1.04 3.63 .86 3.67 .67

9. FORGET 4.17 .97 4.36 .59 4.32 .86 4.16 .98

10. STAFF 3.92 .99 4.06 .67 4.00 .61 3.98 .72

11. HEAR 3.67 1.09 3.75 .81 3.75 .87 3.89 .98

12. APPR 3.00 1.26 2.83 1.05 2.61 1.01 2.67 1.15

13. LVCOND 4.17 .86 4.22 .83 4.23 .83 4.27 .91

14. TREAT 4.57 .37 4.44 .65 4.59 .35 4.49 .89

15. RESRCH 4.06 .55 4.33 .76 3.90 1.05 4.09 .97

* A full description of the items is given in Appendix 6.

2230

Overall, post-test results showed that the JCNH staff have indicat-

ed change toward a more positive attitude ca ten items out of 15, while

similar change was noted for RCNH on nine items. RCNH staff, however,

mairta:ned the same attitude over the tests (mean =3.47 for both tests)

on the item, "I think it's rewarding working with mentally and memory

impaired residents." However, since the index of internal consistency

showed an acceptable level of alpha coefficients in all the tests, for

both experimental and control groups (see Measures section, page 6), we

developed a summative 'Attitude Scale' combining item scores. Both

groups' pre- and post-test results on this scale are presented in Table

10.

TABLE 10

Pre- and Post-Test Mean and Standard Deviation (SD)for Attitude Scale by Nursing Home

Pre-Test Post-Test DifferenceNursing Home Mean SD Mean SD of Mean

JCNH (N =36) 54.31 5.S5 55.14 5.68 (+ .83)RCNH (N =45) 52.63 7.85 54.00 5.64 (+1.37)

(1.68)* (1.14)**

For EntirePopulation 53.37 7.08 54.51 5.65 (+1.14)

* Pre-test mean difference between JCNH and RCNH.** Post-test mean difference between JCNH and RCNH.

It can be seen from this table that the Jackson County Nursing !come

staff had a higher pre-test mean score (54.31) on this attitude scale6

6 Maximum possible score for this scale is 75; a score of over 45 indi-cating a positive, 30-45 indicating a neutral, and below 30 indicatinga negative attitude. An individual's mean item score of 2.0 and belowindicates negative attitude; 2.1 to 3.0 indicates neutral attitude;

and 3.1 to 5.0 indicates positive attitude.

2331

than that of RCNH '52.63). In addition, the Standard Deviation at pre-

test indicated that JCNH staff's scale score had a lover spread around

the mean (5.95 as compared to 7.85 for RCNH). Also, JCNH staff's aver-

age post-test scale score was higher (mean = 55.14) than that of RCNH

(mean = 54.00). However, the difference if mean score between pre- and

post-test for each group suggested that RCNH had an increase of 1.37,

while this difference was .83 for JCNH. The reasons and implications of

this difference will be addressed later in ti-e discussion section of

this report.

SELF-ESTEEM OF THE STAFF: SLIDING PERSON MEASURE

Table 11 shows the pre- and post-test mean and standard deviation

for all ten items included in the Self-Esteem scale by the name of the

nursing homes. On a zero to 100-point scale for each item, the results

show that both groups recorded the highest Self-Esteem for item number

two (variable name = RESP) in both tests. This item measured how the

respondents view themselves, concerning how responsible they are when

caring for Alzheimer's residents. The pre-test Self-Esteem mean score

on this variable for JCNH was 88.30 and for RCNH was 90.10. The post-

test results showed an increase of Self-Esteem for both groups (88.97

and 90.57 respectively). Again, in both the pre- and post-tests the

groups noted lower Self-Esteem for item number five (variable name =

KNOW). This item asked, "When you give care to residents, you feel that

you kdow all you need to know." The post-test mean score on this item

decreased a little for JCNH (mean = 61.84), while the RCNH staff experi-

enced a slight inc, ,e (mean = 64.25).

24 32

TABLE 11

Mean and Standard Deviation (SD) for the 10-Item"Sliding Person Measure" (SPM) by Nursing Home

SPM Items*

JCNH (N =36)

Pre-test Post-test

Mean SD Mean SD

RCNH (N =45)Pre-test Post -test.

Mean SD Mean SD

1. CARE 85.27 16.44 86.11 12.12 88.54 14.95 88.70 10.77

2. RESP 88.32 13.72 88.97 10.27 90.15 11.15 90.57 8.90

3. FELLOW 78.38 17.98 74.86 17.60 77.77 21.89 82.41 15.11

4. YRSELF 86.94 14.08 86.78 12.65 85.56 14.02 87.95 11.09

5. KNOW 62.24 25.64 61.84 20.37 58.91 22.22 64.25 16.78

6. BHRS 80.19 16.39 79.62 16.34 73.63 19.28 74.72 16.40

7. EMG 72.36 19.59 75.46 20.41 66.23 21.20 67.18 20.27

8. NEW 69.95 23.97 76.40 17.03 69.84 24.81 73.73 19 "2

9. DIRECT 78.53 21.25 76.81 20.79 75.07 17.79 78.28 2.. 43

10. ADMIN 71.56 27.66 71.46 24.95 70.23 24.38 74.06 23.25

* A full description of the items is given in Appendix 7.

The second highest Self7Esteem score was a:SO noted for the same

variable (CARE) for both groups in tne pre- and post-tests. This item

asked the question: "When working with residents, show how you view

yourself concerning the care you give." The observed pre-test mean

score on this item for JCNH was 85.27, and for RCNH 88.54. In the post-

test, both groups recorded an increase which was 86.11 for JCNH, and

88.70 for RCNH.

The overa'l summative Self-Esteem scale results, as reflected in

Table 12, showed that JCNH staff had higher mean scores on both the

pre-test (769.14) and post-test (785.89) when compared to RCNH. The

respondents in the latter nursing home recorded a pre-test mean score of

755.07 and post-test mean score of 780.02.

1325

TABLE 12

Pre- and Post-Test Mean and Standard Deviationfor "Sliding Person" Scale by Nursing Home

Pre-test Post-test Difference

Nursing Home Mean SD Mean SD of Mean Score

JCNH 769.14 152.55 785.89 121.03 (+16.75)

RCNH 755.07 126.20 780.02 117.38 (+24.95)

Difference ofMean Score (14.07) (5.87)

When the pre- and post-test Self-Esteem scale scores were compared

separately across the group, JCNH had about ... 14.07 higher average

Self-Esteem score than that of RCNH in the pre-test. In the post-test

this cifference decreased to 5.87, JCNH still having a higher average

scale score. From the pre- to post-test, both groups recorded an

increase of scores; the mean increase of JCNH was 16.75, while it was

24.95 for RCNH.

Tests of Significance for Differences in Knowledge Score,Task Score, and Work Satisfaction Scale Scores Between

JCNH and RCNH

In the previous section, we have discussed the findings on the

differences of mean score between two samples relating t(d their mean

scores on Knowledge, Responsibilities for Tasks, Work Satisfaction,

Attitude toward Alzheimer's Residents, and Self-Esteem scales. Since

the training group (JCNH) is assumed to have significantly higher scores

on all measured scales, further analysis of data involved several one-

tailed t-tests. The results of independent t-tests (differences in

26 14

scale scores between JCNH and RCNH at pre-test, and at post-test) are

presented in Table 13.

TABLE 13

Independent T-Test Results on Knowledge (KNSCOR), Tasks(TASKSCOR), Work Satisfaction (WSSCOR), Attitude (ATTSCOR), andSelf-Esteem (SPSCOR) Scale Scores By JCNH (N=36) and RCNH (N=45)

Variable t-value1-tail

prob.

Nursing

Home MeanStandardDeviation

KNSCORI ** -0.88 0.190 JCNH 14.0000 2.318RCNH 14.5333 3.116

KNSCOR2*** -0.02 0.491 JCNH 14.4722 3.149RCNH 14.4889 3.422

TASKSCORI ** -2.41 0.019* JCNH 7.4722 2.913RCNH 8.9778 2.650

TSKSCOR2*** -1.85 0.068 JCNH 8.2778 2.835RCNH 9.4773 2.929

WKSCORI ** 3.16 0.001* JCNH 30.8611 4.806

RCNH 27.2889 5.350

WKSCOR2*** 3.51 0.001* JCNH 31.4167 4.245RCNH 27.7111 5.251

ATTSCORI ** 1.10 0.140 JCNH 54.3056 5.951RCNH 52.6222 7.852

ATTSC0R2*** 0.90 0.185 JCNH 55.1389 5.683RCNH 54.0000 5.637

SPSCOR1** 0.44 0.333 JCNH 769.1429 152.553RCNH 755.0714 126.204

SPSCOR2*** 0.22 0.415 JCNH 785.8889 121.038

RCNH 780.0238 117.385

* Significant t-values.** Pre-test.

*** Post-test.

. 1r27 -

Table 13 shows that the training group (JCNH) had significantly

higher average scores on the Work Satisfaction scale at the pre- and

post-tests (t-value = 3.16, P = .001 and t = 3.5, P = .001, respective-

ly). These results were in the expected direction. RCNH, on the other

hand, had significantly higher average scores on Responsibility for

Tasks scale on the pre-test (t = -2.41, P =.01), but statistically non-

significant results on the post-test = -1.85, P = .06). The t-tests

measuring differences between the two groups in the Knowledge scale and

Attitude scale were not statistically significant at the pre- or post-

test. Moreover. though the training group (JCNH) recorded higher

average scores than the control group (RCNH) on the Self-Esteem scale at

the pre- and post- tests, both t-tests yielded statistically non-

significant results.

The results of paired t-tests related to each nursing home's pre-

test and post-test average scores for Knowledge, Tasks, Work

Satisfaction, Attitude, and Self-Esteem scales were all statistically

non-significant and, therefore, not presented in this report.

28

IV. DISCUSSION

A comparison of background characteristics of the respondents show

that both sample groups have similar characteristics with regard to sex

ratios and the nature of the job. Most of the respondents who completed

our questionnaires were females and were involved in direct resident

care. But the two samples differed to some extent with regard to age,

education, and work experience. The mean educational level and age of

the control group (RCNH) were higher than the experimental group. For

example, a majority of the respondents in RCNH had greater thar a high

school education as compared to the JCNH staff. Also, the mean age of

the former group was higher (36.2 years) than that of JCNH (33.9 years).

These background differences, apart from training, could perhaps have an

effect on some of the measured dimensions. In terms of duration of job,

the training group, on the average, was employed for a slightly longer

period of time (3.8 years) as compared to the control group (3.6 years).

The question of whether or not the training contributed to the

Knowledge, Tasks, Work Satisfaction, Attitude and Self-Esteem scores of

the experimental group could be answered in two ways: First, through the

comparison of pre-test and pest-test mean scores for all these dimen-

sions across the groups; Second, an examination of independent t-test

values for the significance of results.

With regard to the first point, it was demonstrated that the train-

ing group had consistently increased scores from pre-test to post-test

on all five measured scales. On the additive Knowledge scores, JCNH had

an average increase of .50 whereas, RCNH had experienced a decrease of

29:17

.04 at the post-test measure. The absence of training for the latter

group thus accounts for the inconsistency of results from the pre-test

to the post-test.

Similarly, a comparison of mean differences between the two tests

tor Work Satisfaction and Responsibility for Task scores shows a marked

effect of training on the JCNH staff. This group's average gain for

Task scores was +.89 and for Work Satisfaction scores was +.56 as

compared to that of RCNH, which was +.50 and +.42 respectively.

On the other hand, although the RCNH staff showed a higher average

increase on Attitude scale (+1.37 as compared to +.83 for JCNH) and

Self-Esteem scale (+24.95 as compared to +16.75 for JCNH), their pre-

and post-test mean scores on both these scales were still lower than

that of the JCNH staff. The lower net gains for the JCNH staff could be

a function of the 'regression to the mean' (See Babbie, 1986:191, and

Atherton and Klemmack, 1982:44 for this argument). Since the RCNH staff

had lower scores on both these scales, their net gain could always be

higher than that of JCNH staff because both of these were fixed-point

scales. These results are, therefore, not surprising or even contrary

to our expectations. As such this does not minimize the positive effect

of training on the experimental group whose post-test results on both of

these scales were reasonably substantial.

With regard tc our second point, the significance of t-tests, the

JCNH staff showed significantly higher Work Satisfaction at the end of

training. For the control group, the significant t-value at the pre-

test level (P = .01) and the lack of significant t-value at the

post-test level once again proves their inconsistent results. It is

3018

possible that the lack of training for this group contributed to such

results.

The lack of significant t-test results for other scale scores is

not unexpected. This could he due to the small size of our samples. As

such, our failure to detect statistically significant results for other

scale scores does not prove that the observed differences between pre-

and post-test results of the training group were unimportant for practi-

cal purposes (See Norusis, 1986:226-227 for this argument). It has been

observed that the training did make a differential between the experi-

mental and control groups' mean scores on all measured dimensions.

V. CONCLUSION

Given the extent and nature of Alzheimer's Disease today the impor-

tance of training programs in preparing staff members ;"or providing

more efficient care to AD Afflicted residents in a nursing home setting

can hardly be exaggerated. The training program organized for the JCNH

staff had several desirable effects. First, their satisfaction for

working with mentally impaired and demented residents improved signifi-

cantly after training. Secondly, the kir' of knowledge required to care

for AD afflicted persons also increased. Before training, although most

of the participants from JCNH showed a considerable amount of knowledge

about AD, after training their knowledge level increased further.

Thirdly, the proper knowledge of various Tasks and positive Attitudes

toward AD afflicted residents are important prerequisites for satisfac-

tory care. On both of these dimensions, the training group showed

substantial improvement after training.' Finally, an efficient caregiver

must essentially have a high positive Self-Esteem. In this regard, the

training group also showed improved Self-Esteem after the training.

This training program was not, however, without limitations. One

of the limitations pertains to the voluntary participation in the train-

ing by the JCNH staff. For the purpose of this evaluation, this was

acceptable, yet it lowered the sample size substantially. This factor

also precluded the possibility of random selection of the subjects for

this research. From the training point of view, all staff members

involved with AD residents care should have participated in the training

program without any exception. Future training programs should address

to

this prohlem and seek more cooperation from the nursing home staff.

Thus, better coordination between the group responsible for training and

the nursing home administrators will be essential.

A second problem essentially follows from the first one. That is,

there had been sne variations in the attendance of the training

sessions. Some of the staff members participated in all of the

sessions, but in most cases the attendance varied from one to six

sessions. Since we eve compared only the mean differences of pre- and

post-tests related to various scale scores, the overall result might

have been affected by the nature of participation. Attendance in all

sessions by the training group as compared to no participation by the

control group could have shown more striking differences between the two

group's post-test results. Once again, future training programs' better

coordination with the nursing home administrators might help solve such

problems.

Finally, the question of whether or rot training contributed to the

observed increase in the post-test average scale scores of the JCNH

staff could be more conclusively answered through a multivariate form uf

analysis, taking into consideration all the background (independent)

variables along with t, ining as a key independent variable. The non-

random nature and small size of the sample, however, precluded any such

analysis for the present study. The expansion and replication of this

training program in more nursing homes may open up dossibilities for

more sophisticated analysis through random ..-election of subjects for

evaluation purposes.

4133

Despite these limitations, the overall rc ults suggest that a

training program such as this one is worth repeating and replicating in

view of the urgent needs of Alzheimer's Disease afflicted persons

currently residing in various nursing homes in Minis and throughout

the Ur'ted States.

4234

APPENDICES

43

. ._

APPENDIX 1

ALZHEIMER'S DISEASE RESEARCH DESIGN PROJECT

Jackson County Nursing Home and Southern Illinois University

KICK-OFF EXERCISE

The "Kick-Off" exercise will help our research demonstration and evaluation ofthe training program you will be an important part of during the next ninemonths. Responses are anonymous. Nowhere on the answer sheet will your name

appear. However, so that we may match-up your responses today with theresponses on an "Exit Replay" questionnaire at the completion of training,please write the last four (4) digits of your social security number in thespace requested both on this form and on the answer sheet. The score youreceive will allow you to compare your responses to the others who haveparticipated. Please hand in both the questionnaire and the answer sheet.

Please use a soft lead penC1 when marking your answer, and heavily color in

the circle on the answer sheet. Your answers will be machine scored.

ID number:

Sex: Female _ _ _Male

A. WORK AND EDUCATIONAL EXPERIENCE

1. fiat is your education level?

One through eight years 1

Incomplete High Schocl 2

High school completA 3

Some college (1-3 years) 4

College graduate 5

Post-graduate study 6

2. How long have you worked at Jackson County Nursing Home?

Less than three months 1

3-6 months 2

7-12 months 3

Over one year 4

3. How long have you worked in your present position?

Les; than three months 1

3-6 months 2

7-12 months 3

Over one year 4

3544

4. What is your position?

CNA 1

Rehabilitation Aide 2

Bookkeeper 3

Activity Aide 4

Housekeeper 5

Social Service Assistant 6

Laundry Aide 7

Administrative Clerk 8

Charge Nurse 9

Supervising Nurse 10

Dietary Aide 11

Receptionist 12

Maintenance 13

5. What shift do you usually work?

Day shift 1

Evening shift 2

Night shift 3

B. KNOWLEDGE EXERCISE

The following questions review your knowledge of the aging process andexperiences of caregivers. Answers will be discussed in class.

Please circle; True or False for each answer.

1. Senile dementia is a normal age-related change. T F

2. A person's environment and lifestyle do not affect the speed ofhis/her aging process. T F

3. Some age-related changes occur in some people but not in others. T F

4. The majority of persons 65 and over do not have adequate healthto live independently. T F

5. Even though there are physical changes accompanying old age,most older people are able to cope well because the changes aregradual enough that they are able to make the necessarypsychological and emotional changes. T F

6. Caregiving stresses are interrelated. The effect of one stressmay directly or indirectly influence all of the caregiversfunctioning. T F

7. The stresses of caregiving seldom cause increased health problemsfor the caregiver. T F

8. It is usually best to make decisions for residents without

T Fconsulting them.

36 4 5

9. A caregiver's. feelirg about his/her own aging do determine thequality of care he/she gives to the resident.

10. Even though a caregiver may resent having to take care of a

residen.., he/stie can usually hide those feelings from theresident if he/she tried hard enough.

11. A good relationship between an older family member and his/hercaregiver can become even closer if healthy patterns of relatingtogether are continued.

1? A caregiver should not try to find time for himself/herselfif the residents seem to need constant attention.

13. It is common for caregivers to feel guilty during their

14. A person my age more rapidly if he/she does not have

opportunities to communicate with others.

caregiving experiences.

15. Residents will .eel more secure and happier if family membersor staff take complete control of their lives.

. .

16. When a stroke victim cannot speak, this is usually an indicationthat he/she cannot understand what others say to him/her.

17. A person involved in caregiving runs a higher risk of illness

unless he/she has a planned support syetem to fill the gaps. T F

18. Continued friendships seem to promote higher morale amongpersons than do ongoing family relationships.

19. A caregiver can give ongoing support to residents even if he/shedoes not receive any support.

20. Caregivers sometimes feel guilty about transferring certainresponsibilities to family members.

C. RESPONSIBILITY FOR TASKS

Who do you think should be responsible for the following tasks--nursing homestaff, resident's family and staff jointly, or the resident's family:

NursingHome Joint Family

21. Provide special foods (extras) --r- 2 ----1-

22. Make sure resident's room is attractive 1 2 3

23. Give birthday party for resident 1 2 3

24. Report any abuse or neglect to authorities 1 ? 3

37/16

25. Ensure that drugs/medication not coveredby Medicare/medicaid are ordered 1 2 3

26. Make a telephone accessible to resident 1 2 3

27. File claims for resAent benefits 1 2 3

28. Transport resident to doctor 1 2 3

29. Provide adequate supplies (kleenex, etc.) 1 2 3

30. Launder residee's personal clothing 1 2 3

31. Mark resident's personal clothing 1 2 3

32. Keep resident's clothing inventory up-to-date 1 2 3

33. Clip finger and toe nails 1 2 3

34. Arrange for hair grooming 1 2 7,

35. Make current newspaper available 1 2 3

36. Keep books, magazines available 1 2 3

D. WORK SATISFACTION

Please indicate the number representing the degree of satisfaction you havewith the following aspects of your job. The scale is:

1= Very dissatisfied2= Dissatisfied3= Neutral4= Satisfied5= Very satisfied

37. My pay and the amount of work I do 1 2 3 4 5

38. The praise I get for doing a good job 1 2 3 4 5

39. The way nursing home policies are putinto practice 1 2 3 4 5

40. The working cond'tions 1 2 3 4 5

41. The way my co-workers get along witheach other 1 2 3 4 5

42. The feelings of accomplishment I get

from the job 1 2 3 4 5

38

47

43. The chance to do different things fromtime to time 1 2 3 4 5

44. The chance to do things for other people 1 2 3 4 5

45. The chance to work with confused residents 1 2 3 4 5

Please indicate the extent to which you agree or disagree with each of thefollowing statements. The scale is:

1= Disagree strongly2= Disagree3= Neutral4= Agree5= Agree strongly

46. I prefer working with residents who knowwhat tell 1they want and can me their needs

47. I feel comfortable around confused residents 1

48. I think it's fun working with mentally andmemory impaired residents

49. I don't think most of the residents cando much for themselves

50. I would rather do things mysel:' than waitfor help 1

51. I don't think that the resident's familieswant to do very much for them 1

52. I think that the resident's families areusually more trouble than help 1

53. I believe that I can influence the wayresidents behave 1

1

54. The residents are so confused that itreally doesn't matter what you saybecause they will forget it anyway 1

55. I think it's possible to coordinate staffto work with residents in a planned way 1

56. I think it's best to tell the residentswhat they want to hear, even if it's notthe truth 1

57. I don't feel that my work is appreciatedas much as it should be 1

WS

2 3 4 5

2 3 4 5

2 3 4 5

4 5

2 3 4 5

2 3 4 5

2 3 4 5

2 3 4 5

2 3 4 5

2 3 4 5

2 3 4 5

2 3 4 5

58. I don't think that improvements can bemade to improve residents living condition

59. I think that it is important to treatthe residents as individuals

60. I think the research belongs inschoolbooks, not in the workplace

Thank you very much for your cooperation.

4049

1 2 3 4 5

1 2 3 4 5

1 2 3 4 5

APPENDIX 2

SOCIAL SE:":URITY#

(LAST 4 OEGITS)

SLI0Ii,c PERSON MEASURE

SAMPL'.. EXERCISE

Look at the line below. Think of yourself asperson A. Pretend th line Wow is a scalefrom 0 to 10. The. 54 is zero or poor, andthe person figure is 10 or perfect.

Now put your pencil at the * and move italong just above the line. Stop at the pointwhich shows how close you are now to beingPe-son t. Mark that Kilt on your line withan X.

Go ahead. Draw your ine and mark an "X" onthe line below it.

Now try this example. When I wake from sleepin the morning, it helps me to get my daystarted right if I have a cup of coffee.

Produced for the Alzheimer's Oisease Afflicted Project with theJackson County Nursing Home and the Division of Continuing Education,Southern Illinois University at Carbondale.

41 50

Please answer all of the following items in the same way as you did onthe other page. That is, for each statement, draw a line, starting atthe star and stopping at the point which shows how close you are tobeing as you would like to be for that statement. Mark with an "X"the end point of each line that you draw.

When working with residents, show how you view yourselfconcerning the care you give.

When caring for residents, show how you view yourselfconcerning how responsible you are. A

Show your view of yourself when you think ofhow your fellow workers regard the quality of your work.

4hen you work with residents, show your view of yourselfconcerning how good of a job you are doing.

When you give care to residents, you feel thatyou know all that you need to know.

42

51

When residents have needs and show unusual behavior,show how you feel about handling the situation effectively.

*When an emergency comes up, show how comfortable youare of handling it better than your fellow workers.

7A7

Show how comfortable you are to use new skills winthe residents.

*When you work with residents, show how you feel thatthe director of nursing services believes you aredoing a good job.

*When you work with residents,show how you feel thatthe administrator believes you are doing a good job.

What is your job title?

How long have you worked on this job?

Your age?

Sex F M ---

43 52

APPENDIX 3

(abbreviated names are shown in the left column for each item)

OEM =Senile dementia is a normal age-related change.

LIFE =A person's environment and lifestyle do not affect thespeed of his/her aging process.

SOME Some age-related changes occur in some people but not inothers.

DEP =The majority of parsons 65 and over do not have adequatehealth to live independently.

COPE =Even though there are physical changes accompanying old

age, most older people are able to cope well because thechanges are gradual enough that they are able to make thenecessary psychological and emotional changes.

STRESS,-,Caregiving stresses are interrelated. T)e effects of onestress may directly or indirectly influence all of the

caregivers functioning.

CGSTR =The stresses of caregiving seldom cause increased healthproblems for the :.aregiver.

DEC. =It.is usually best to make decisions for residents without

consulting them.

DUAL =A caregiver's feelings about his/her own aging do determinethe quality of care he/she gives to the resident.

HIDE =Even though a caregiver may resent having to take care of aresident, he/she can usually hide those feelings from theresident of he/she tries hard enough.

GOREL =A good relationship between an older family member andhis/her caregiver can become even closer if healthy patternsof relating together are continued.

SELF =A caregiver should not try to find time for himself/herselfif the residents seem to need constant attention.

GUILT =It is common for caregivers to feel guilty during theircaregiving experiences.

RAPID =A person may age more rapidly of he/she does not hliVe

opportunities to communicate with others.

RESHAP=Residents will feel more secure and happier if family members

or staff take complete control of their lives.

NOTALK=When a stroke victim cannot speak, this is usually anindication that he/she cannot understand what others say to

him/her.

,534q

CGILL = A person involved in caregiving runs a higher risk of illness unlesshe/she has a planned support system to fill the gaps.

FRSP Continued friendship seem to promote higher morale among persons thando ongoing tame y relationships.

CGSUP = A caregiver can give ongoing support to residents even if he/she doesno receive any support.

RESPON = Caregivers sometimes feel guilty about transferring certainresponsibilities to family members.

45

54

APPENDIX 4

RESPONSIBILITY FOR TASKS

(Abbreviated variable names are shown in left column for each item)

XFOOD = Prwide special foods (e:-.tras)

ROOM = Make sure resident's room is attractive

BPARTY = Give birthday party for resident

REPO'" = Report any abuse or neglect to authorities

DRUGS = Ensure that drugs/me- :nn not covered by Medicare/medicaid are

ordered

PHONE = Make a telephone accessible to resident

CLAIMS = File claims for resident to doctor

PANS = Transport residen to doctor

SUPP = Provide adequate supplies (Kleenex, etc.)

WASH = Launder resider 's personal clothing

MAkK . Mark resident's personal clothing

CLOTH = Keep resident's clothing inventory up-to-date

CLIP = Clip finger and toe nails

NAIR = Arrange for hair grooming,

NEWS = Make current newspaper available

READ = Keep books, magazines available

4655

APPENDIX 5

WORK SATISFACTION

(abbreviated variable names are shown in left column for each item)

PAY = My pay Frid the amount oc work I do

PRAISE = The praise I get for doing a good job

POLICY = The way nursing home policies are put into practice

WKCOND = The working conditions

COWK = The way my co-worker get along with each other

WKSAT = The feelings of accomplishment I get from the job

WKVAR = The chance to do different things from time to time

OTHERS = The chance to do things for other people

CONFUS = The chance to work with confused residents

5647

ACTITUDE TOWARDS ALZHEIMER'S RESIDENTS

(abort fated variable names are shown in left column for each item)

NOCONF = I prefer working with residents who know what they wart and can tell

me their needs.

OKCONF = I feel comfortable around confused residents.

OKMN11 = I think it's rewarding working with mentally and memory impaired

residents.

OTHLP = I don't think most of the residents can do much for themselves.

MYSELF = T would rather do things myself than wait for help.

FAM = I don't think that the resident's families want to do very much for

them.

TRBL = I think that the resident's families are usually more trouble than

help.

IHELP = I believe that I can influence the way residents behave.

FORGET = The residents are so confused that it really doesn't matter what yousay because they will forget it anywly.

STAFF = I think it's possible to coordinate staff to work with resident's in

a planned way.

HEAR = I think it's best to tell the residents what they want to hear, even

if it's not the truth.

APPR = I don't feel that my work is appreciated as much as it should be.

LVCONO = I don't think that improvements can be made to improve residentsliving condition,

TREAT I think that it is important to treat the residents as individuals.

RESRCH = I think the research belongs in schoolbooks, not in the workplace.

57

48

APPENDIX 7

SLIDING PERSON MEASURE

(abbreviates variable names are shown in left column for each item)

CARE = When working with residents, show how you view yourself concerningthe care you give.

RESP = When caring for residents, show how you view yourself concerninghow responsible you are.

FELLOW = Show your view of yourself when you think of how yc..r fellowworkers regard the Quality of your work.

YRSELF = When you work !ith residents, show your view of yourself concerninghow good of a job you are doing.

KNOW = When you give care to residents, you feel that you know all thatyou need to know.

BHRS = When residents have needs and show unusual behavior, show how youfeel about handling the situation effectively.

EMG = When ar emergency comes up, show how comfortable you are ofhandling it better than your fellow workers.

NEW = Show how comfortable you are to use new ski1,3 with the residents.

DIRECT = When you work with residents, show how you feel that the directorof nursing services believes you are doing a good job.

ADMIN = When you work with patients, show how you feel that the administratorbelieves you are doing a good job.

8

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BIBLIOGRAPHY

Atherton, Charles R. and David L. Kiemmack1982 Research Methods in Social Work. Lexington, MA: D.C. Heath.

Babbie, Earl1986 The Practice of Social Research (Fourth Edition). Belmont, CA:

Wadsworth Publisning.

Campbell, Donald T. and Julian Stanley1963 Experimental and Quasi- Experimental Designs for Research.

Chicago: Rand McNally.

Cronbach, L.J.1951 Coefficient Alpha and the Interal Structure of Tests.

Psychometrika 16: 297-334.

Dietsch, L. and J. Pollman1982 Alzheimer's Disease Advances in Clinical Nursing. Journal of

Gerontnlogical Nursing 8(2): 97-100.

Norusis, Marija J.1985 The SPSS Guide to Data Analysis. Cnicago: SPSS Inc.

"huttlesworth, G. and A. Rubin1983 Engaging Families as Support Resources in Nursing Home Care:

Ambiguity in the Subdivision of Tasks. The Gerontologist

23:632-636.

Springer, D. and T.H. Brubaker1984 Family Caregivers and rependent Elderly: Minimizing Stress and

Maximum Independence. Beverly Hills, CA: Sage Publications.

SPSS Inc.

1986 SPSS-X User's Guide, 2nd ed.. Chicago: SPSS Inc.

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